Archive for October, 2017

While the outcomes of patients diagnosed with multiple myeloma have significantly improved, there continues to be a need for new therapeutic approaches. As is the case with many other cancers, there has been great interest in the possibility of harnessing the power of the immune system to attack the myeloma cells. One such approach is the use of natural killer (NK) cell therapy.

NK cells are a type of white blood cell. NK cells play important roles in immune defenses against infected cells and tumor cells and also help regulate the immune response. As their name suggests, these cells have the ability to kill other cells. There are factors found on the surfaces of the NK cells and the potential target cells that help signal to the NK cells and let them know whether the target cell is abnormal or foreign to the body and therefore should be killed or whether the target cell is normal and therefore should not be killed. Because of the ability of NK cells to recognize and kill cancer cells, there has been much interest in the use of these cells as anti-cancer therapy.

Nancy Gessmann of Harlan, Iowa, is enrolled in the clinical trial at Nebraska Medicine. Watch her story below.

There are two main approaches to using NK cells as anti-cancer therapy. One involves using the patient’s own NK cells while the other approach is to use a donor source for the NK cells. One problem with using a patient’s NK cells is that NK cells in cancer patients are often dysfunctional – the cancer cells can interfere with the activity of NK cells and therefore “escape” the NK cells. In addition, prior chemotherapy treatments can make it difficult to collect sufficient numbers of healthy NK cells. Thus, the alternative approach of using donor NK cells is being studied. The donor NK cells that have been studied thus far in clinical trials have either been collected from healthy donors or have been derived from umbilical cord blood cells and grown in a laboratory. The latter approach has the advantage of being “off-the-shelf,” thus a patient does not have to wait for the availability of a donor.

Currently, Nebraska Medicine is participating in a clinical trial involving cord blood-derived NK cells for multiple myeloma patients. The strategy that is being investigated in this study is to add the NK cellular therapy into the standard bone marrow transplant procedure that many myeloma patients undergo. The standard bone marrow transplant (autologous stem cell transplant) involves the collection of the patient’s stem cells, followed by high-dose chemotherapy, followed by infusion of the stem cells. For patients enrolled in the NK cell trial, an infusion of the NK cells is given after the infusion of their own stem cells. The purpose of this study is to determine what the optimal timing of the NK cell infusion is relative to the stem cell infusion and to make sure that the NK cells can be given safely. The hope is that the NK cell infusion, given after the high dose chemotherapy and during the time when the bone marrow (and immune system) is being re-set, will optimize the ability of the NK cells to target and kill any remaining myeloma cells.

It is an exciting time for cancer research. We are learning more and more every day about how to use the power of the immune system to fight cancer. NK cell therapy may prove to be a new strategy that can improve the outcomes of patients with myeloma.

In recognition of its expertise in serving adults with congenital heart disease (CHD), Nebraska Medicine and Children Hospital & Medical Center’s joint Adult Congenital Heart Disease program has received accreditation from the Adult Congenital Heart Association (ACHA), a nationwide organization focused on connecting patients, family members and healthcare providers to form a community of support and network of experts with knowledge of CHD.

Individuals with CHD, the most common birth defect diagnosed in one in 100 births, are living longer. There are now 1.4 million adults in the U.S. living with one of the many different types of congenital heart defects that range from simple to complex. The Nebraska Medicine/Children’s program annually treats around 1,500 ACHD patients from across the region at both institutions.

“Already home to Nebraska’s only board certified experts in ACHD, the program is now one of the country’s first to be nationally accredited in comprehensive care,” says cardiologist and congenital heart disease specialist Shane F. Tsai, M.D., the program’s medical director. “This distinction reflects our ability to provide extraordinary multidisciplinary services, and patients can feel confident that they are receiving the highest quality of care in the region.”

Shane Tsai, MD
The joint program received accreditation by meeting ACHA’s criteria, which includes medical services and personnel requirements, and going through a rigorous accreditation process, both of which were developed over a number of years through a collaboration with doctors, physician assistants, nurse practitioners, nurses and ACHD patients.

“This accreditation recognizes not only that we provide exceptional cardiac care, but also comprehensive expertise and support for ACHD patients at every stage,” explains pediatric and adult congenital cardiologist Jon Cramer, M.D. “We offer care for a teen’s transition to adult care, a pregnant patient in need of increased monitoring, unique OB/GYN care, specialized anesthesia services and all aspects of cardiac treatment and intervention. The ACHA acknowledges that this breadth of services leads to better patient outcomes and experiences.”

“There are now more adults than children in the U.S. with CHD,” says Mark Roeder, president and CEO of ACHA. “Accreditation will elevate the standard of care and have a positive impact on the futures of those living with this disease. Coordination of care is key, and this accreditation program will make care more streamlined for ACHD patients, improving their quality of life.”

Nebraska Medical Center is again honored to announce its recognition by Vizient, Inc., as a recipient of the 2017 Bernard A. Birnbaum, MD, Quality Leadership Award. The award recognizes Nebraska Medical Center for demonstrating superior quality and safety performance among more than 100 academic medical centers taking part in Vizient’s Quality and Accountability Study. Only twelve academic medical centers in the United States were recognized this year. Nebraska Medical Center is ranked eleventh and is the only health system in the region to earn this recognition.

“At Nebraska Medicine, the safety of our patients and the quality of care we provide to them comes above everything else,” says CEO Dan DeBehnke, MD, MBA. “To be recognized for something this important and for something we’re continually trying to improve upon validates the effort we’ve been making. Everyone who works here should be extremely proud of this honor, especially earning it for a second straight year.”

12 in the nation. Only 1 in Nebraska. National Leaders in Quality and Safety.*

This year, 107 academic medical centers and 161 community hospitals were included in the study. The study measured performance based on the Institute of Medicine’s six domains of care: safety, timeliness, effectiveness, efficiency, equity and patient centeredness. The composite scoring system uses patient-level performance data from a variety of sources, including the Vizient Clinical Data Base, the Vizient Core Measures Data Base, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, and the Centers for Disease Control and Prevention’s National Healthcare Safety Network.

Nebraska Medicine – Bellevue also earned a spot on the community hospitals list, checking in at twelfth.

James Wisecarver, M.D., Ph.D., has been elected president of the American Society for Clinical Pathology (ASCP). Dr. Wisecarver, who will serve a one-year term, assumed the presidency at the ASCP annual meeting held Sept. 6-8 in Chicago.

Dr. Wisecarver serves as the vice chair for clinical affairs for the UNMC Department of Pathology/Microbiology and director of the Human DNA Identification Laboratory at UNMC. He also serves as medical director of the clinical laboratories at UNMC’s clinical partner, Nebraska Medicine.

Dr. Wisecarver received his medical degree from UNMC in 1986 and a doctorate in physiology from Creighton University in 1978. He completed a residency in combined anatomic and clinical pathology at UNMC and then joined the department of pathology and microbiology in 1990.

His involvement in ASCP has included serving on the Council on Continuing Education, and later on the board of governors of the ASCP Board of Registry (now Board of Certification).
While serving on the board, he helped organize a new examination committee to develop the molecular biology examination and the associated credential that is now being offered through the

ASCP Board of Certification. He also organized and presented molecular diagnostics workshops offered through ASCP and the United States and Canadian Association of Pathology.

“Dr. Wisecarver’s strategies for optimizing laboratory test utilization are recognized nationally,” said Steven Hinrichs, M.D., the Stokes-Shackelford Professor of Pathology and Chair at UNMC. “We are extremely fortunate to have Dr. Wisecarver as a member of our faculty and his expertise in laboratory science is reflected in the high quality of our services.”